Optimal timing of surgery for active infective endocarditis with cerebral complications: a Japanese multicentre study

被引：52

作者：

Okita, Yutaka ^{[1
]}

Minakata, Kenji ^{[2
]}

Yasuno, Shinji ^{[3
]}

Uozumi, Ryuji ^{[2
]}

Sato, Tosiya ^{[4
]}

Ueshima, Kenji ^{[3
]}

Konishi, Hiroaki ^{[5
]}

Morita, Naomi ^{[6
]}

Harada, Masafumi ^{[7
]}

Kobayashi, Junjiro ^{[6
]}

Suehiro, Shigefumi ^{[8
]}

Kawahito, Koji ^{[9
]}

Okabayashi, Hitoshi ^{[10
]}

Takanashi, Shuichiro ^{[11
]}

Ueda, Yuichi ^{[12
]}

Usui, Akihiko ^{[13
]}

Imoto, Kiyotaka ^{[14
]}

Tanaka, Hiroyuki ^{[15
]}

Okamura, Yoshitaka ^{[16
]}

Sakata, Ryuzo ^{[17
]}

Yaku, Hitoshi ^{[18
]}

Tanemoto, Kazuo ^{[19
]}

Imoto, Yutaka ^{[20
]}

Hashimoto, Kazuhiro ^{[21
]}

Bando, Ko ^{[21
]}

机构：

[1] Kobe Univ, Grad Sch Med, Div Cardiovasc Surg, Dept Surg, Kobe, Hyogo, Japan

[2] Kyoto Univ, Grad Sch Med, Kyoto, Japan

[3] Kyoto Univ Hosp, Kyoto, Japan

[4] Kyoto Univ, Sch Publ Hlth, Kyoto, Japan

[5] Konishi Cardiovasc Med Clin, Shimonoseki, Yamaguchi, Japan

[6] Natl Cerebral & Cardiovasc Ctr, Osaka, Japan

[7] Univ Tokushima, Tokushima, Japan

[8] Osaka City Univ, Grad Sch Med, Osaka, Japan

[9] Jichi Med Univ, Shimotsuke, Japan

[10] Iwate Med Univ, Morioka, Iwate, Japan

[11] Sakakibara Heart Inst, Okayama, Japan

[12] Nara Prefecture Gen Med Ctr, Nara, Japan

[13] Nagoya Univ, Grad Sch Med, Nagoya, Aichi, Japan

[14] Yokohama City Univ, Med Ctr, Yokohama, Kanagawa, Japan

[15] Kurume Univ, Sch Med, Kurume, Fukuoka, Japan

[16] Wakayama Med Univ, Wakayama, Japan

[17] Kobe City Med Ctr Gen Hosp, Kobe, Hyogo, Japan

[18] Kyoto Prefectural Univ Med, Kyoto, Japan

[19] Kawasaki Med Sch, Kurashiki, Okayama, Japan

[20] Kagoshima Univ, Grad Sch Med & Dent Sci, Kagoshima, Japan

[21] Jikei Univ, Sch Med, Tokyo, Japan

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 2016年 / 50卷 / 02期

关键词：

Infective endocarditis; Cerebral complications; Timing of surgery; CARDIAC-SURGERY; IMPACT; HEMORRHAGE; EMBOLISM; STROKE; RISK;

D O I：

10.1093/ejcts/ezw035

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The aim of this study was to investigate the effect of the timing of valve surgery on the clinical outcomes of patients with active infective endocarditis (IE) accompanied by cerebral complications. We retrospectively analysed a cohort of 568 patients, comprising 118 with non-haemorrhagic cerebral infarction (CI), 54 with intracranial haemorrhage (ICH) and 396 without cerebral events (C; control), who underwent surgery for left-sided active IE in 15 Japanese institutes from 2000 to 2011. The mean age was 58.4 +/- 16.9 years in the CI group; 54.5 +/- 17.4 years in the ICH group and 56.9 +/- 16.0 years in the C group. Clinical outcomes were analysed according to the timing of surgery after the diagnosis of CI or ICH was made. In the CI group, there were 9 (7.6%) hospital deaths, 13 (11%) new cerebral events and 1 (0.8%) redo valve surgery. In the ICH group, there were 3 (5.6%) hospital deaths, 8 (14.8%) new cerebral events and 2 (3.7%) redo valve surgeries. In the C group, there were 36 (9.1%) hospital deaths, 23 (5.8%) new cerebral events and 9 (2.3%) redo valve surgeries. Risk factors for hospital death were prosthetic valve endocarditis (P = 0.045), high C-reactive protein (CRP; P < 0.001) and the elderly (P < 0.001) in the CI group. Delayed surgery (2 weeks after CI) seemed result in a higher incidence of hospital death in the CI group. Patients who had surgery between 15 and 28 days or after 29 days from the onset of CI had higher incidences of hospital death [odds ratio 5.90 (P = 0.107) and 4.92 (P = 0.137), respectively] compared with those who had surgery within 7 days. In the ICH group, risk factors for hospital death were high CRP (P = 0.002) and elderly (P < 0.001). Contrary to CI patients, patients who had surgery between 8 and 21 days or after 22 days after the onset of ICH had lower incidences of hospital death [odds ratio 0.79 (P = 0.843) and 0.12 (P = 0.200), respectively] compared with those who had surgery within 7 days. Although statistically insignificant, early surgery in active IE patients with CI is safe, but very early surgery (within 7 days) should be avoided in patients with ICH.

引用

页码：374 / 382

页数：9